A clinicopathological study of 15 autopsy cases with allogeneic bone marrow transplantation in special reference to graft versus host disease (GVHD).

A clinicopathological investigation was made on 15 autopsy cases with allogeneic bone marrow transplantation. Engraftment was recognized in 11 patients, 6 out of which survived more than 100 days postgrafting, and 5 terminated within 100 days. The other patients succumbed to sepsis before engraftment. In 8 evaluated cases with clinical acute graft versus host disease (GVHD), involvement of acute GVHD was histologically confirmed in the skin, liver, and/or intestine. Atypical ductal changes similar to those of interlobular bile ducts were noted in the pancreas and esophageal gland in a patient with severe acute GVHD. Although 6 long-term patients showed neither definite lichenoid papulae nor sicca syndrome diagnostic for clinical chronic GVHD, 4 patients exhibited prolonged hepatic dysfunction and/or abnormal serological tests suggestive of autoimmunity, and they had some degree of basal vacuolar degeneration with or without lymphocytic infiltrates in the dermis, and atypical degeneration of small bile ducts at the same level as seen in acute GVHD ranging 20 to 50 micron in diameter. Chronic sialoadenitis with atypical epithelial degeneration was evident in two of them. A major cause of death was interstitial pneumonia of viral or fungal etiology due to persistent immunodeficiency.